Provider Demographics
NPI:1063469195
Name:HUDSON, ROCHELLE JESSICA (O,D,)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:JESSICA
Last Name:HUDSON
Suffix:
Gender:F
Credentials:O,D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 AIRPORT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4501
Mailing Address - Country:US
Mailing Address - Phone:207-873-6048
Mailing Address - Fax:207-877-9513
Practice Address - Street 1:40 AIRPORT RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4501
Practice Address - Country:US
Practice Address - Phone:207-873-6048
Practice Address - Fax:207-877-9513
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT885152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEV07599Medicare UPIN
MEHU-ME1708Medicare ID - Type Unspecified